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Clinical Reviewer

2 months ago

Columbia, South Carolina, United States US Tech Solutions, Inc. Full time
About the Role

We are seeking a highly skilled Clinical Reviewer to join our team at US Tech Solutions, Inc. As a Clinical Reviewer, you will play a critical role in ensuring that our members receive the necessary healthcare services while maintaining the highest level of quality and cost-effectiveness.

Key Responsibilities
  • Conduct thorough reviews of medical or behavioral eligibility to determine benefits and clinical criteria
  • Apply clinical expertise, administrative policies, and established clinical criteria to service requests or provide health management program interventions
  • Utilize clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness
  • Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits
Requirements
  • 2 years of clinical experience
  • Working knowledge of word processing software
  • Ability to work independently, prioritize effectively, and make sound decisions
  • Good judgment skills
  • Demonstrated customer service, organizational, and presentation skills
Preferred Qualifications
  • Working knowledge of spreadsheet, database software
  • Knowledge of contract language and application
  • Thorough knowledge/understanding of claims/coding analysis/requirements/processes
About US Tech Solutions, Inc.

US Tech Solutions, Inc. is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. We are committed to delivering exceptional service and support to our clients and partners.

We are an Equal Opportunity Employer and welcome applications from diverse candidates. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.